Healthcare Provider Details

I. General information

NPI: 1144206863
Provider Name (Legal Business Name): RUTH ANGELA WANDERA DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 COLUMBINE RD ANDERSON LAKES CENTER
EDEN PRAIRIE MN
55344-6695
US

IV. Provider business mailing address

8785 COLUMBINE RD ANDERSON LAKES CENTER
EDEN PRAIRIE MN
55344-6695
US

V. Phone/Fax

Practice location:
  • Phone: 952-941-7393
  • Fax: 952-941-2162
Mailing address:
  • Phone: 952-941-7393
  • Fax: 952-941-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD11618
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD11618
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: